Raccoon Rabies To Blame For Recent Transplant Death

An investigation has determined that organ transplantation is the source behind a fatal case of raccoon rabies virus that took place earlier this year.

In February of this year, a kidney recipient with no reported exposure to potentially rapid animals died from rabies 19 months after the transplant. About two human rabies deaths are reported in the US every year, and for years all but two cases were associated with bats. Raccoons are the most frequently reported rabid animal in the US, but this was the first reported case of human rabies associated with the raccoon rabies virus.

Neil M. Vora, M.D. of the Centers for Disease Control and Prevention (CDC) in Atlanta and colleagues conducted a study to determine whether organ transplantation was the source of the virus exposure to the recipient. They reviewed organ donor and all transplant recipient medical records for the study, and conducted laboratory tests.

The researchers found that the kidney donor’s symptoms prior to death were consistent with rabies. Interviews with family members revealed that the donor had significant wildlife exposure and had sustained at least two raccoon bites. Brain tissue tests later confirmed the presence of the rabies virus antigen.

Three other organ recipients from the same donor did not have signs or symptoms consistent with rabies or encephalitis. They have remained asymptomatic, with rabies virus neutralizing antibodies detected in their serum.

“This transmission event provides an opportunity for enhancing rabies awareness and recognition and highlights the need for a modified approach to organ donor screening and recipient monitoring for infectious encephalitis. This investigation also underscores the importance of collaboration between clinicians, epidemiologists, and laboratory scientists,” the authors wrote in the journal JAMA.

Daniel R. Kaul, M.D., of the University of Michigan Medical School said that during the past decade, numerous instances have been reported of donor-derived infection with pathogens associated with central nervous system infections, such as rabies or the West Nile virus, among recipients of solid organ transplants.

“Educational efforts to improve recognition of donors with CNS infection and the risks associated with using these donors should be directed not just at the transplant community but at the larger community of physicians involved in the care of potential donors – particularly critical care specialists, neurologists, and infectious disease physicians,” Kaul said.

He added that clinicians may be unaware of the potential for donor-derived infection, but accepting transplant centers must rely on the clinician impression made by those caring for the potential donor.

“Although the risk of donor-derived disease is inherent in the process of organ transplantation and cannot be eliminated, raising awareness of the risk of using donors with undiagnosed CNS infection is the best way to reduce the occurrence of these transmissions,” Kaul added.